With appalling health systems failing to meet even the primary healthcare needs of more than a billion people, it is not going to be easy to meet the tobacco cessation needs in India, says Bobby Ramakant. But sooner and faster we proceed, all the better.

Despite rising taxes and increasing restrictions against tobacco use in India, an alarming number of young people are beginning tobacco use every year. Union Health and Family Welfare Minister of Government of India Dr Anbumani Ramadoss informed our parliament that there are more than 25 crore tobacco users in India. And if you go by WHO statistics, over 50 percent — 12.5 crores — of them will die prematurely of a tobacco related disease. Not only quitting tobacco is difficult (and often unsuccessful) for an individual, but also it's not easy to integrate tobacco cessation services in existing healthcare services effectively so as to help an estimated 25 crore of tobacco users in India to quit tobacco use and save needless burden of diseases and deaths.

"Why can't we integrate tobacco cessation in already existing health systems? India has a massive network of primary to tertiary level healthcare systems across the country, and the effort should be to do 'value addition' of healthcare professionals by building their capacities in tobacco cessation" says a veteran frontline tobacco control advocate Professor (Dr) Rama Kant.

Strengthening of tobacco control legislations and the many diseases — 29 on the World Health Organization (WHO)'s last count, including stroke, heart diseases, various cancers and emphysema — associated with tobacco use are bringing in a change with India's youth perceiving tobacco as a killer. The National Sample Survey Organization conducted a study during 1993-2004 which concludes that there is a 30% decline in tobacco consumption in urban India. The proportion of households with beedi smokers has also declined across the rural-urban divide, by 26-35%.

However many studies show higher tobacco use rates in medical students than in the general population. With a considerable section of healthcare professionals themselves using tobacco, how effective tobacco-cessation advocates will they become?

With deceptive tobacco advertising and misconceptions associated with tobacco use, the addiction takes roots before the age of 18, says Prof Kant. Adolescence is the age of adventure, exploration and naivety. By the time tobacco-related hazards begin to manifest, the person is already addicted to nicotine dose. Nicotine is as addictive as heroin and cocaine, stated a US Surgeon General Report in 1988. It is not easy to quit tobacco, but it is also not impossible, asserts Prof Kant.

Nicotine is a psychologically and physically addictive substance. Psychological and pharmacological aids are available to help people quit tobacco use, although success rates are relatively low. So far India has about 20 tobacco cessation clinics supported by World Health Organization across the country, mandated with the mountainous task of facilitating tobacco cessation for a population of 25 crore tobacco users!

How will we scale up tobacco cessation services in India? Should we invest astronomical amount of money in creating a new speciality of tobacco cessation experts, or rather build capacity of existing healthcare staff? Before we do that healthcare workers should be encouraged to quit tobacco and 'choose life' as the WHO slogan says.

There are lot of learning lessons from other public health interventions in India. Disease control and public health programmes of tuberculosis, AIDS, reproductive health, family planning and other related spheres have existed in isolation initially and only later over a considerable period of time we realized the benefits of integration. Not only resource maximization is achieved by integrating programmes as those of TB and HIV, or reproductive health, family planning and HIV, but also it is more sustainable and increases the overall effectiveness of health interventions.

It is vital for health policy makers to understand that the best way is certainly not to resurrect tobacco cessation facilities all across India rather to integrate tobacco cessation in existing healthcare systems. And this makes it all the more vital to urgently respond to the daunting challenge posed by weak health systems.

Also it is high time for healthcare professionals to 'do what they preach' — be a role model of a healthy lifestyle.

Tobacco use continues to be the second biggest cause of death in the world, according to the WHO. It currently kills about 50 lakhs people — one in 10 adult deaths — each year globally. According to the Indian Council of Medical Research (ICMR) tobacco use is responsible for over 10 lakh deaths in India each year, which is about 3000 deaths every day.

The urgency to reduce or decimate preventable burden of life-threatening diseases attributed to tobacco is compelling. There is no place for complacency. To reduce this goliath burden, not only we need to reduce the number of youth, who may begin tobacco use, but also we need to scale up quality tobacco cessation services and make it accessible, affordable and available to the most underserved communities at the earliest.

A serious commitment to arresting nicotine dependency is fundamental. Although significant proportions are successful, many people fail several times. Many tobacco users find it difficult to quit, even in the face of serious tobacco-related disease in themselves or close family members or friends.

Moreover unless tobacco users have access to quality affordable tobacco cessation services, how will we enforce anti-tobacco legislations and smoke-free air policies in India overnight? Knowing that nicotine is as addictive as heroin or cocaine (US Surgeon General Report 1988), ignoring the healthcare needs of tobacco using people is being naïve.

Bobby Ramakant, who serves as The Seoul Times' Asia correspondent, is a member of NATT, Network for Accountability of Tobacco Transnationals, and edits Weekly MONiTOR series, reporting violations of tobacco control policies as a senior public health and development journalist. He writes for newspapers in 11 countries and can be reached at bobbyramakant@yahoo.com)